【作者】 张晶；

【导师】 王斌全；

【作者基本信息】 山西医科大学 ， 护理学（专业学位）， 2017， 硕士

【摘要】 目的:采用现况调查方法了解脑卒中失能老年患者康复期的ADL能力及辅助器具使用情况,并进一步采用病例对照研究探讨轮椅的操作指导及健康教育对脑卒中失能老年患者康复效果的影响,以重视辅助器具在康复护理领域的应用,为优化康复护理及延续护理提供借鉴。方法:采用方便抽样法,筛选2015年12月至2016年11月在康复科住院的脑卒中失能老年患者133例作为研究对象,使用一般资料调查表、辅助器具使用现状调查表,进行基本资料及辅助器具使用的现况调查。排除12例不使用轮椅的脑卒中失能老年患者,干预研究对象为使用轮椅的121例患者,按随机数字分组法将121例研究对象分为对照组61例,干预组60例。两组患者在一般资料、EDAS评分、MMSE评分等方面的差异无统计学意义(P>0.05),干预组进行轮椅操作指导及健康教育,对照组进行常规脑卒中健康教育,电话随访3个月。以Barthel指数评定量表、躯体功能SPPB量表、社会支持SSRS量表、综合医院焦虑抑郁问卷HAD评分等为观察指标,评价移动辅具的操作指导及健康教育对两组患者康复效果的影响。结果:现况调查结果显示133例患者,男71例、女62例,年龄65~89岁,平均72.18岁;重度失能24例(18.05%),中度失能75例(56.39%),轻度失能34例(25.56%);121例(90.98%)患者使用轮椅,99例(74.44%)患者未接受过辅助器具健康教育,且多数患者存在辅助器具使用安全隐患。数据分析显示干预组患者干预后的ADL得分明显高于干预前(P<0.001);干预后,干预组不同失能程度患者的躯体功能SPPB、社会支持SSRS、焦虑抑郁程度HAD得分也均高于对照组(P<0.05),差异有统计学意义。结论:辅助器具的规范化健康教育,可有效改善脑卒中失能老年患者的临床康复疗效及出院时的生活自理能力,可强化和加深辅助器具的重要性,可优化康复护理,同时为后期延续护理的效果维持提供了一种新思路。更多还原

【Abstract】 Objective:Adopt the method of survey to investigate the ADL and the using situation of assistive products,and further using case-control study to discuss the effect of operation guidance and health education of wheelchair on rehabilitation efficacy in disabled elders with stroke,in order to pay attention to the application of assistive products in the field of rehabilitation care,then provide a reference for optimizing rehabilitation and continuation of care.Methods:This study included 133 elderly patients with stroke who received rehabilitation from December 2015 to November 2016 during convalescence in our department by convenient sampling,the general information questionnaire and the assistive products’ use status questionnaire were used to make an inventory survey upon basic data and assistive products.Except 12 cases for disabled elder stroke patients who don’t use wheelchair,the intervention study included 121 patients who use wheelchair,divided into control group 61 cases and intervention group 60 cases by andomized blocks,two groups of patients had no significantly statistical difference in the general information,EDAS score and MMSE score data(P>0.05),the operation guidance and health education of assistive products were used in intervention group,and traditional health education in control group,then telephone follow-up for 3 months.The Barthel index rating scale,the body function SPPB,the social support SSRS,and the HAD scale were used to evaluate the effect of rehabilitation between two groups upon the operation guidance and health education of the mobile assistive products.Results:The survey showed totally 133 patients,male 71,female 62,age 65-89,an average of72.18 years old;24(18.05%)patients were severely disabled,75(56.39%)patients were moderately disabled and 34(25.56%)patients were mildly disabled;121(90.98%)patients using wheelchair,99(74.44%)patients were not accepted the health education of assistive products,and most patients has the potential safety hazard of the use of assistive products.Data analysis showed that the socre of ADL after the intervention is obviously higher than before the intervention for intervention group(P<0.05);After the intervention,Intervention group patients was higher than the control group on body function SPPB,social support SSRS,psychological HAD scores(P<0.05),and the difference was statistically significant in patients with different degree of disability.Conclusion:The health education of assistive products can effectively improve the clinical curative effect and the self-care ability for disabled elder stroke patients when they leaving hospital,can strengthen and deepen the importance of assistive products,can optimize the rehabilitation nursing,and at the same time provides a new way of thinking for maintaining the effect of the continuation nursing in the later stage.更多还原